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Avatar universal

RE: Concerns over healed Genital Herpes/HIV and NSU

Dear H. Hunter Handsfield. M.D,

Before I write my concerns I would like to thank you for all your previous posts that I have found both informative and helpful in the past.

Firstly, the NIAID (National Institute of Allergy and Infectious Diseases) carried out research regarding the link between healed genital herpes sores and an increased chance of contracting HIV. Please see the link below.


From your previous posts I understand that the likelihood of contracting HIV from an HIV positive female during a single episode of unprotected penile/vaginal intercourse is extremely low.

However, bearing in mind the recent research, if a similar exposure includes a healed herpes sore are the chances significantly increased or only increased by a little?

Secondly, five years ago a UK GUM clinic confirmed that I was negative for both Chlamydia and Gonorrhea and told me that I had NSU. The NSU has been recurrent since but before being diagnosed I experienced similar NSU symptoms growing-up and as a virgin.

The NSU is not a major problem rather just a nuisance that comes and goes occasionally.

Yet, during unprotected sex am I putting future female partners at risk of contracting anything? Furthermore, can it cause sterility in men? Can I continue as before, regarding it as a nuisance and ignoring it without any follow-up treatment?

Thank you once again for your previous posts. I look forward to hearing from you. Take care.

7 Responses
239123 tn?1267651214
Welcome to the forum.

Thanks for citing an important research study.  However, it is not news that HSV-2 increases the risk of sexual acquisition of HIV if exposed; that has been known for 15+ years.  That is not the point of the more recent research you cite.  The study has helped to understand why treating HSV-2 doesn't reduce the risk.  (The study was not done by NIH, but by colleagues and close friends at the Univeristy of Washington, Drs. Larry Corey and Anna Wald.  I often say that all I know about herpes I learned from them.)

On average, having HSV-2 roughly doubles the risk of catching HIV, if exposed.  For the average heterosexual man or woman in the US, having sex with new partners from time to time, the risk of catching HIV is near zero.  Doubling an almost zero risk still leaves almost zero risk.   Alternatively, look at it like this: for a new heterosexual encounter with unprotected vaginal sex with a partner whose HIV status is unknown, the chance of catching HIV probably is around 1 in a million.  Double that risk if one partner has HSV-2 makes the risk 1 in 500,000.  No big deal.

I'm not disparaging the importance of HSV-2 in HIV transmission.  On a global scale, up to half of all sexually acquired HIV infections might be attributable to HSV-2.  And it is good if people with HSV-2, knowing of the elevated risk, are more careful about common sense in selecting partners, using condoms, etc.  But when all is said and done, having HSV-2 doesn't make much difference for most sexually active people in industrialized countries.

Turning to your recurrent NGU (the US term, more often called NSU in the UK):  you are correct that it is reasonably considered just a nuisance, not an important health problem.  The causes are unknown. Initial NGU is usually sexually acquired, but once treated, subsequent recurrences seem to be due to an inflammatory response that recurs despite eradication of the original cause, and recurrent NGU is not known to be associated with any disease or bad outcome in affected men's sex partners.  However, a few cases might be due to things like trichomonas, and perhaps to other emerging STD organisms like Mycoplasma genitalium.  If the problem persists and you haven't recently been evaluated by an STD expert -- e.g. your local NHS GUM clinic, or an excellent private STD provider like Freedom Health (London), that might be a good idea.

I hope this helps.  Best wishes--  HHH, MD
Avatar universal
Thank you for the speedy reply. Very informative. Much appreciated.

Regarding the NSU issue, should I be concerned with it causing male infertility?

Many thanks again.

239123 tn?1267651214
Recurrent NGU/NSU is not known to cause infertility or any other long term health outcome in affected men.

Thanks for the thanks. Stay safe.
Avatar universal
Sorry Doctor,
Just one more thing.
To clarify, merely having HSV-2 even without a herpes sore doubles your risk of catching HIV or do does the increased risk only apply to when you have a sore present (newly healed or open) at the time of intercourse?

Many thanks,
239123 tn?1267651214
The HSV-2 effect is indepedent of symptoms or recognized outbreaks.  Simply having a positive blood test for HSV-2 predicts the elevanted risk of HIV.  The main point of the research you cite is that it helps explain why overt herpes lesions need not be present and why herpes treatment makes no difference.

That should wind up this thread. Take care.
Avatar universal
Will be safe. Have a good day.

Kind regards,
Avatar universal
A related discussion, Herpes and HIV was started.
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